Laserfiche WebLink
INTENDED ti1SIV <br />• r) Industrial <br />0 owngsziorrivipt <br />71'PE Of WELL <br />1] Opers Ilortor.o <br />o Gravel Peek <br />OeAttion a Wail CliJanelef <br />$4/ I ete)r_I Distrviel Depth <br />TYPE QF SEP WORK; NEW INS.TALLATION I REPAIR/ADDITION I 0E5181/ODOM I I thlo tootle eystein pennettsel 14 piAbtfic lows( <br />evialatrka within 200 Isit.1 <br />Rea.Ling Mete:lel k Depth <br />O7/24/199 6 II:3T rpom TO 12e9464V1f.9 <br /> <br /> <br />APPLICATION <br />SAN JOAQUIN COUNTY PUBLIC IMALlii SIERVICT-S <br />vutONMENTAL HEALTH DIVISION <br />44$ N SAN JOAQUIN. PHONE CAM-469.4*W <br />P 0 BOX 388, STOCKTON, CA 95201-0388 <br />2Vgi Kika ISMl AMUIL-Mtnin <br />(COmplete in Triplicate) • <br />0)(i1111/6 <br />Appheetiort ie hereby mid, re See lossiolo (Downy fix- pmmtt to cony:tom anWor install the work berrin drIC2ibr4- This Application is roads hi eOttiplistoce with $on <br />Joaquin County Development Title Stttion 9-11103 Sod Section 0-111t..1 nod the Rules and Rigulations of San JogrepAn C.Jurity Pnblic ifsalsh gehqcci. <br />../Ob Adders* 145 SUTTER ST. <br />SAN JOAQUIN COUNTY <br />CAPITAL PROJECTS _ <br />Cy ION Lot Slet/AereAge <br />Ackafes4 222 E. WEkgi, AVE_, #67 IL, sTo.cmp Phone ..7-99461811_.., <br />. , <br />°WM'S Neovili <br />P.O. fox 336 <br />Ccette octoe brj2 -iM_4M131j1111ii,IE Adrift. I IUO VI STA, CA. .9457J Liense No. 5o. 6.39 P1ortt J07-374-4n <br />TYPE Of WELL/PUMP: NEW WFI El <br />PUMP INSTALLATION <br />OtSIANCE TO NEAREST: SEPTIC TANK N/A <br />FGUNDATION 20 <br />WELL flEPLACEMFNT I DESTRUCTION <br />SYSTEM REPAIR 0 OTHER <br />SEWER LINES _15 DISPOSAL FLO_ N/A <br />TU AGRICULRE WELL WA__ OTHER WELL 14 t <br />Out of gertrit* <br />Itooltorlses Well <br />PROP LINE ' <br />Pits/smuts NM <br />ci <br />P IN Other <br />nonli.toring 60 <br />Icriwnion - Apprept, Depth. <br />mama( Work conne 13 Type of PIMP <br />PecieLERA ARIA <br />El Manteca <br />- Tracy <br />Dew <br />I I Easeem <br />H. P. <br />CONSTRUCTION SPECiFiCATIONS <br />Dia o9 Waft Ereevailon -UFA- nie. or We Carina LI) <br />-typo ad c.,ki g srmriftesiorw -NIA <br />Depth of GlOvI Si.s.V N/A TVI). DroirantilaiLlir.-- <br />Suriaoe Seas InotelltHi by <br /> State Work Done <br />Application Accepted by <br />LJ <br />Float inapection by <br />translation MI serve: Residence cono...ciRe othor <br />fl'ATOIP Of IMPS ucuia ---- Number of bedrooms <br />Chltreetfit tit soil to a depth of 3 flint Water table depth <br />Capacity,. No. Compartment* <br />Method rat Disposal <br />Property Line <br />SEPTIC TANK 0 Type/Mfg <br />PKO. TREATMENT PLT, <br />Oilstone@ In neerplie: Well F000datiOn <br />Cl No. !I Length of ---- "Total tenth/ gas <br />eislarice to nearest Wee Fotmoation PHoony Una <br />SEEPAGE PITS I I Depth Sire Number <br />SWAPS Dietense to nearest: Ws R foundation - ProCtserY <br />DISPOtAL PONDS 0 <br />LEACHING LiNg <br />Krim SED <br />I heralw tiertify that I two, Plettrarod tnic &Peek:shoo end that the work wet be don* in accordance writh San JOSCIOIrt county artanances, <br />rotes pod nagspletioos of the San JoscArirs Gamow <br />Home owner or boomed egent'll Signature ©articles the following: "I cant!), OW in the pedal-manta of the work for which this pewit iestikiad, I shag not <br />emPloY any WON' in ouch Ptonflof Ps to boDOWICIlobtaccl to_reorlimiles corriparisanon Iowa of Celiforrits." Connector's hiring or ei,ob-epriareettog Iknonute <br />Cliffirgot th !oIcwn 1 oorlifY Or in Wei perforteseeta of rhe work Per whictf rhu Pecmil ii issued. I ehettl ernpeoy person subject le yisenkfivwx oompenii. tiOn Wes of Callforole:'• <br />TM applicant most esti for ell required in Compts <br />trIgnIPa <br />tog on rovers/ side. <br />TIME _ Date: <br />FOR DEPARIMENT USE ONLY <br /> ()5l.7 -L; <br />" Ofool Ifilloection by Eire <br />Cornovents: D f 51cilvt <br />Applicant - Return all copiers tot LaitlosquiritaffnoryiE e up iel IleabhServic y. as <br />-44S N. San Jeegoin, P.O. DOX M. &tactual, CA 9S7i3 I <br />CIE <br />INFO AMOUNT" [WE AMOUNT REMitito CASH RECEtvEct BY GATE <br />'I? <br />Pfallir NO. <br />-15f1SWAO_iteei M 7 01 `TIE ilL <br />t11,011 0 3 1,39,